Poll: Return-to-Play Screening Strategy for Athletes After COVID-19

Early in the COVID-19 pandemic, uncertainty regarding the incidence of SARS-CoV-2 related myocarditis raised concern on how to manage athletes who had been infected. One year ago, initial expert consensus recommendations from the American College of Cardiology Sports and Exercise Cardiology Section veered conservative out of an abundance of caution influenced by the evidence at the time, in which high rates of myocardial injury were seen in hospitalized patients with COVID-19.1 Now, much more data are available on the prevalence of myocarditis in professional2 and collegiate3,4 athletes recovering from COVID-19, overall suggesting a low prevalence of myocardial involvement in this population.

This past week, a new study published in JAMA Cardiology reviewed data from collegiate athletes in the Big 10 COVID-19 Cardiac Registry.5 In their study, the authors state that a symptom-guided cardiac screening strategy resulted in a clinical myocarditis prevalence of 0.31% (5/1597), and a strategy incorporating an electrocardiogram (ECG), echocardiogram, and troponin measurement would have led to a prevalence of 1.1% (17/1597). However, they found that screening with a cardiac magnetic resonance imaging (CMR) on all athletes, regardless of symptoms, led to an increased prevalence of 2.3% (37/1597), though the significance of the abnormal CMR findings in isolation remains unclear. In particular, the lack of appropriate controls and independent core lab review of CMRs remain critical limitations of this study.


  1. Phelan D, Kim JH, Chung EH. A game plan for the resumption of sport and exercise after Coronavirus Disease 2019 (COVID-19) infection. JAMA Cardiol 2020;5:1085-86.
  2. Martinez MW, Tucker AM, Bloom OJ, et al. Prevalence of inflammatory heart disease among professional athletes with prior COVID-19 infection who received systematic return-to-play cardiac screening. JAMA Cardiol 2021;Mar 4:[Epub ahead of print].
  3. Moulson N, Petek BJ, Drezner JA, et al. SARS-CoV-2 cardiac involvement in young competitive athletes. Circulation 2021;Apr 17:[Epub ahead of print].
  4. Hendrickson BS, Stephens RE, Chang JV, et al. Cardiovascular evaluation after COVID-19 in 137 collegiate athletes: results of an algorithm-guided screening. Circulation 2021;143:1926–28.
  5. Daniels CJ, Rajpal S, Greenshields JT, et al. Prevalence of clinical and subclinical myocarditis in competitive athletes with recent SARS-CoV-2 infection: results from the Big Ten COVID-19 Cardiac Registry. JAMA Cardiol 2021;May 27:[Epub ahead of print].

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Sports and Exercise Cardiology, Magnetic Resonance Imaging, Sports and Exercise and Imaging

Keywords: Sports, Athletes, COVID-19, SARS-CoV-2, Myocarditis, Prevalence, Incidence, Consensus, Uncertainty, Electrocardiography, Magnetic Resonance Imaging, Registries, Troponin

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